{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T02:41:00Z","timestamp":1790995260021,"version":"4.1.0"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,7,6]]},"abstract":"\n Background<\/jats:title>\n \n Our dual aims were as follows: (1) to classify new or recurrent myocardial infarctions (\n MI<\/jats:styled-content>\n ) in patients with stable atherosclerosis using the Universal Definition of\n MI<\/jats:styled-content>\n classification system; and (2) to characterize the effects of vorapaxar, a first\u2010in\u2010class platelet protease\u2010activated receptor \u20101 antagonist, on new or recurrent\n MI<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We analyzed data from\n TRA<\/jats:styled-content>\n 2\u00b0P\u2010\n TIMI<\/jats:styled-content>\n 50, a multinational, randomized, double\u2010blind, placebo\u2010controlled trial of vorapaxar. This analysis included 20\u00a0770 patients with previous\n MI<\/jats:styled-content>\n or peripheral arterial disease without a history of transient ischemic attack or stroke. Each new or recurrent\n MI<\/jats:styled-content>\n after randomization that met the trial end point definition was further categorized according to the European Society of Cardiology, American College of Cardiology, American Heart Association, World Heart Federation Universal Definition classification of type and size. Of 1095 incident\n MI<\/jats:styled-content>\n s, 77% were spontaneous (Type 1), with a smaller number (9.8%) of secondary\n MI<\/jats:styled-content>\n s (Type 2). Vorapaxar reduced Type 1\n MI<\/jats:styled-content>\n (hazard ratio [\n HR<\/jats:styled-content>\n ] 0.84,\n CI<\/jats:styled-content>\n 0.73\u20130.98,\n P<\/jats:italic>\n =0.024), with a similar pattern for Type 2\n MI<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n 0.74,\n CI<\/jats:styled-content>\n 0.49\u20131.10,\n P<\/jats:italic>\n =0.13). Notably, vorapaxar showed a consistent pattern of reduction across size of\n MI<\/jats:styled-content>\n s, including\n MI<\/jats:styled-content>\n s in the highest Universal\n MI<\/jats:styled-content>\n size class (\u226510\u00d7 upper reference limit,\n HR<\/jats:styled-content>\n 0.83,\n CI<\/jats:styled-content>\n 0.70\u20130.98,\n P<\/jats:italic>\n =0.025). As such, there was a significant reduction in larger, spontaneous\n MI<\/jats:styled-content>\n s (Type 1, \u226510\u00d7 upper reference limit,\n HR<\/jats:styled-content>\n 0.81,\n CI<\/jats:styled-content>\n 0.67\u20130.99,\n P<\/jats:italic>\n =0.036), and a consistent pattern with respect to fatal\n MI<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n 0.66,\n CI<\/jats:styled-content>\n 0.39\u20131.11,\n P<\/jats:italic>\n =0.12).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Among stable patients with established atherosclerosis, the most common type of incident\n MI<\/jats:styled-content>\n is spontaneous\n MI<\/jats:styled-content>\n , and the reduction in\n MI<\/jats:styled-content>\n with vorapaxar was consistent across\n MI<\/jats:styled-content>\n s of varying type and size, including spontaneous infarctions \u226510\u00d7 upper reference limit.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 00526474.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.116.003237","type":"journal-article","created":{"date-parts":[[2016,7,19]],"date-time":"2016-07-19T03:08:33Z","timestamp":1468897713000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Universal Classification System Type of Incident Myocardial Infarction in Patients With Stable Atherosclerosis: Observations From Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2\u00b0P)\u2010TIMI 50"],"prefix":"10.1161","volume":"5","author":[{"given":"Stephen K.","family":"Kidd","sequence":"first","affiliation":[{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc P.","family":"Bonaca","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"Braunwald","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano M.","family":"De Ferrari","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, University of Pavia, Italy"},{"name":"Department of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil S.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piera A.","family":"Merlini","sequence":"additional","affiliation":[{"name":"IV Divisione Cardiologia, Azienda Ospedaliera Niguarda Ca\u2019 Granda, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina A.","family":"Murphy","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin M.","family":"Scirica","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvey D.","family":"White","sequence":"additional","affiliation":[{"name":"Green Lane Cardiovascular Service, Auckland City Hospital, West Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Morrow","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"},{"name":"Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1200933"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001505"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706482"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.09.011"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31826e1058"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2009.06.027"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.09.037"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.041160"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(12)60341-6"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/2048872614554109"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht104"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.02.541"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.833665"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2013.09.031"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318235eb4d"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.574830"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.116.003237","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:12:24Z","timestamp":1715595144000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.116.003237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7,6]]},"references-count":16,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2016,7,6]]}},"alternative-id":["10.1161\/JAHA.116.003237"],"URL":"https:\/\/doi.org\/10.1161\/jaha.116.003237","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,6]]},"assertion":[{"value":"2016-01-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-06-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-07-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e003237"}}